1

OT

24 8 9 2 OT50

37 63.613

70.5

OTPerformance Status

PS 4 Numeric Rating Scale NRS

121

PS 2.13.4

0.05

NRSOT

7

2 11 1

2 75

3

12 3

1

17 46%

― 60 ―

20

2

13 35% activity411% ADL 3 8%

431% 4 31% ADL 323% activity2 15%

32 86%activity3 8% ADL 2 6%

11 84 activity1 8%ADL 1 8%

OTR14 38% 10 27%

13 35%8 62%

OTR 3 23%2 15%

12OTR

OT

OT PS

PS0,1,2PS3,4

ADL

OT NRS

3 OT

OT

OTR

OTR

QOL

1Vol.36,No.4,2010.3,pp397-401

2

3 pp8 2012 3

2011 pp27 37

― 61 ―

1

1 2

1 1 1 1 2

33

50 X 3 295 16

WHO Grade3

2

23

2 1 3

1 2

153

179JCS2-30

3

184 PT

JCS1-2203

OT 205 V-P Shunt

( MSW)MSW

( )214

JCS1-3 ADL

OTADL

PT OT

MSW

― 62 ―

21

2

220 Best Supportive Care5

225

270

1OT

10

OT

ADL

MSW

3

― 63 ―

1

3

1) 70

2) IOPI Iowa Oral Performance Instrument Northwest 3)

IOPI1 / 5 / 3

12

4) -1)

-2)

RSST VF Penetration-Aspiration Scale score

-3)

Oral Diadochokinetic Ability

100 5)

1 80 55

6 2 70

405 6

1) 1 (1) 23kPa 39kPa ( 1) 0.54 /sec 0.92 /sec

(2)

(3) Oral Diadochokinetic Ability

3.5 3.5

― 64 ―

22

2

100 42.656.6 /d//ts//rj/

/o/ / /

2) 2 (1)

2 12

Oral Diadochokinetic Ability

Robbins 8010

1)Robbins J,Kays SA,Gangnon RE,Hind JA, Hewitt AL,Gentry LR,Taylor AJ : The ef-fects of lingual exercise in stroke patients with dysphagiaArchPhysMedRehabil 2007 ; 88 : 150 158 2)Yeates EM,Molfenter SM,Steele CM : Improvements in tongue strength and pressure-generation precision following a tongue-pressure training protocol in old-er individuals with dysphagia: three case reports. Clin Interv Aging 2008 ; 3 : 735

747 3)Robbins J, Gangnon RE, Theis SM, Kays SA, Hewitt AL, Hind JA The Effect of Lingual on Swallowing in Older Adults J Am Geriatr Soc 2005 ; 53 1483-1489

1: 1 ( :kPa, : )

2: 2 ( :kPa, : )

― 65 ―

2009perioperative management cen-

ter :PERIO.PERIO

..

PERIO .

2008 8 2010 12

29 . 2008 20095

15 7 862.7 8.1 A PERIO2010 4 2010 12

PERIO 1413 1 62.6 8.1B PERIO .

. BMI

ICU.A B

.

Welch's t-test 5% .

A BBMI

FEV1.0 %FVC . A 3,2 B 1,6

BA 11,2 B 2,6 B

. A 42,6 B29,9 B 1

4 . .

1 P .05

2 ICU N.S. :Not Significant

day

N.S.

― 66 ―

23

3 P .05

4 P .05

PERIO

.

.

1. PERIO.

2. PERIO.

3. PERIO .

1

URL:www.okadaimasui.com/jp/patient/perio.html 2012 10 29 2

. 2010;43,5 487-494 3

2. 2006 4

no.9,51-55 4

. 2006 3,43-47

5 Nagamatsu,Y. et al Preoperative evaluation of cardiopulmonary reserve with the use of expired gas analysis during exercise testing in patients with squamous cell carcinoma of the thoracic esophagus.J Thorc cardiovasc Surg.2001 121,1064-1068 6 William D schweickert Early physical and occupational therapy in mechanically ventilated,critically ill patients a ran-domized controlled trial.Lanset 2009vol373 1874-1882

― 67 ―

1

Respiratory Physical TherapyRPT

ECMO RPT1)

ECMO RPT

8 RS

PPHN PDA SpO2

1ICU

Vital Sign BP 100-105/62-65mmHg HR 136-144bpm SpO2 92-95% 73-79% EtCO2 62-80mmHg, ABG pH 7.265 PaO2 77.3mmHg PaCO2

75.4 mmHg HCO3 33.1 mmol/L

Evita®4BIPAP assist

55bpm FiO2 1.0 PIP23cmH2O PEEP6cmH2O VT 20ml

4 RPT5

ECMO V-V ECMO tubetube

11

X

RPT RPTBP 145mmHg HR 160bpm

BIPAP assist,FiO20.35,PIP28cmH2O, PEEP16cmH2O

20BP HR SpO2

post liftingVT 11ml 15ml

ABG pH 7.447 PaO2 198mmHg PaCO2

47.0 mmHg HCO3 31.9 mmol/L1 2 1 8

12 X

PIP22cmH2O PEEP13cmH2O VT 20ml

13

BP HR RPT

― 68 ―

24

2

PIP28cmH2O PEEP16cmH2O 19ECMO

20 ABG pH 7.160 PaO2 51.5mmHg PaCO2 92.9 mmHg HCO3 31.3 mmol/L ECMO

V-A 13 25BP HR

26

post lifting

RPT VT 10ml 32

FiO20.30,PIP26cmH2O, PEEP12cmH2Obagging

squeezing BP HR

VT 25ml ABG pH 7.462PaO2 197mmHg PaCO2 35.8 mmHg HCO3 25.2

35 ECMO 38ECMO tube

VT30ml PEEP

10cmH2OX

RPTECMO

HIGH PEEP

RPTRPT

post lifting squeezing

RPT

20

post lifting baggingsqueezing

ECMO tube

PPHN PDA

RPT

RPT

45

20

ECMO tube

1

3 ECMO3

2006 18 59-64

― 69 ―

1 ― 70 ―

25

2

preVAS40 ROM -5

125 / MMT5/4MMT5/4 10 8

12 48.2cmVAS10 ROM

-5 135 /MMT5/5 MMT5/5

10 6 1570.1cm

RF TARF TA MG

BF3

Hesse 2) 10

BF TA MG BF

3)

4)

1) Aldo O.Perotto

142-195 1985 2) Hesse S, Werner C, Seibel H, von

Frankenberg S, Kappel EM, Kirker S, Käding M : Treadmill training with partial body-weight support after total hip arthroplasty : a randomized con-trolled trial. Arch Phys Med Rehabil. 2003 ; 84 : 1767-73

3) Hof AL, Elzinga H, Grimmius W, Halbertsma JP : Speed dependence of averaged EMG profiles in walking. Gait Posture. 2002 ; 16 : 78-86

4) Hubley-Kozey CL, Hill NA, Rutherford DJ, Dunbar MJ, Stanish WD : Co-activation differences in lower limb muscles between asymptomatic con-trols and those with varying degrees of knee osteoarthritis during walking. Clin Biomech. 2009 ; 24 : 407-14.

― 71 ―

1

1 Timed Up & Go Test

1 2 3

1 2 1 1 2 2 3 1 1 2

1.THA 3 1 TUG

― 72 ―

26

2

2.THA 3 1TUG

3.THA TUG

― 73 ―

1

RA TEA ROM 1 2

, ,

RA TEA:

Total Elbow ArthroplastyROM

TEAROM

TEA RA 36 1

35 37 59.8 10.320 17 TEA

TEA ROM

1 2 3 3 3 ROM

130 A 130 B2 ROM

5

TEA ROM3

-36.2 -26.1 112.2126.8(p<.01)

A 24 25 12 13B 12 12 8 4

2 3 A B

AROM ROM

23

A1 ROM A

B2

TEA ROM

-36.2±20.2 112.2±28.3 PO1W -28.5±9.3 100.8±12.2 PO2W -25.3±10.1 115.2±9.6 PO3W -23.4±11.1 120.6±11.3 PO3M -26.1±12.7 126.8±10.8

2 A 130

-31.0 18.5 123.3 12.6PO1W -26.6 8.5 102.0 13.6PO2W -23.0 9.4 116.9 9.4PO3W -19.8 9.8 125.2 6.8PO3M -21.2 11.8 132.8 2.9

― 74 ―

27

2

3 B 130

-47.1 20.1 99.2 26.3PO1W -32.5 10.1 98.2 8.5PO2W -30.0 10.4 111.5 9.3PO3W -30.8 10.2 111.1 12.9PO3M -36.3 7.4 114.2 10.4

1 ROM

* p<.01

ROM 3 3

ROM 130 130 ROM

ROM

ROM

RA TEA ROM 3 ROM

2

PO1W PO2W PO3W PO3M

**

― 75 ―

1

TKA

2009 2011 TKA

8877.0 4.6

ADLFIM

27

3

FIM 6

( )6

54(2 33 ) 6.5464 84 32.8

T (T-cane )9.1 2

21 6.89 6982 34.6

T-caneT-cane

― 76 ―

28

2

ADL

1

― 77 ―

1

― 78 ―

29

2 ― 79 ―

1

4

A 60

H23.5B

H23.11

H24.3

B R S ROM STEF 83 52

HDS-R 26/30 MMSE 25/30 TMT-A 571 TMT-B

/ ADL FIM 90/126

ADL

OT/PT/ST/

ADLOT

3

― 80 ―

30

2

1 OT/ST

OT

― 81 ―

1

2

2

6

A (ST 12 )

12

SLTA 39/40 86/91 40/4038/41 19/20

WISC- VIQ114 PIQ106 FIQ111 ST OT

ITPA(STRW) C

61 9 2 7

3 8 4

A 32 3 ST

6

ITPA STRW( 1) 2

ITPA ( 1)3

A

2

A ST

― 82 ―

31

2

1 ( 1 )

ST

2 ( 2ST

()

3 3)

10

A

A (1)(2)

A

1 ( )

A

A

2 ( 2) ST A

A

ST

A

ST

23 A

A

ST

― 83 ―

1

HAL

,

HAL Hybrid Assistive Limb; HAL CYBERDYNE

1

HALHAL

HAL

2012 8 HAL 810

HAL

Brunnstrom stage

HAL

HAL

HAL

123

68

63

51

91 1

13

2 34 1

70 ADL

Japan Coma Scale -1 412

( 12Gr.) 9FACT 2 14

512Gr. 8 FACT9

10 12Gr.8, FACT915m

12 HAL1 30 HAL

2

12 1912Gr. 8 8 FACT9

― 84 ―

32

2

20 50.1 66.7HAL 10m 2

7.8m/min 22.5m/min 10m50 35 Cadence

HAL 10m

HAL

719

100m 3

HAL

HAL

HAL

HALHAL

HAL

HAL

3 3 HAL

HAL

HAL

HAL HAL

HAL

HAL

HAL

HAL

HAL

, HAL(Hybrid Assistive Limbs) .

2012 11 3 25-34

FACT .2006 21 4 357-362

2012 40 7 983 990

― 85 ―

( PMD )

PMD

PMD 2HAL (CYBERDYNE

( ) Hybrid Assistive Limb HAL)(HAL)

1 Kugelberg-Welander 52 H17 MMT2~3

2

52 19 MMT3

Trendelenburgrocking

HALHAL

MVP-RF80 (MicroStone )

HAL 10m

1 2( 1)

( 2 3)

1 1 pre post

(m/sec) 20.9 0.92 31.4 0.21 (cm) 42.1 0.42 49 0.28

(step/min) 49.6 2.90 64.1 0.07

2 pre post (m/sec) 55.8 0.14 58.7 2.33

(cm) 51.4 0.49 52.8 1.13 (step/min) 108.6 1.34 111.1 2.61

― 86 ―

33

2)

2

PMD 2 HAL

HAL

PMD

1) 119

( ) ( )2007 pp101-108

2) 2004 38 89-97

2 ( ) 1 2 (mHz) pre post pre post

0.793 0.549 1.709 1.892 0.793 0.549 0.916 0.977 0.397 0.549 0.916 0.977

3 ( ) 1 2 (mHz) pre post pre post

4.395 4.882 0.397 0.549 1.709 1.892 3.387 3.926 1.77 1.892 0.214 1.009

― 87 ―

1

9

( GBS)

( ) GBS

GBS

( OT) ADL

9 ( )

2 GBSIVIg

5 OT ( NCS)

CMAP

OT ( 5 )

GBS grade4

MMT 54 3

2 3 ( 1kgf

) MMT 3(90) 3

23

10 1cm

( )( )

ADL

ROMex

13 grade3 MMT 5

5 4 1kgf2.2kgf 1kgf 3kgf

( )

ADL OT

― 88 ―

34

2

17 grade3 MMT 5

5 4 3.2kgf5.0kgf 2.5kgf 5.5kgf

( )

24

OT

OT

ADL

28 grade3 MMT 55 4 5.5kgf

7.0kgf 6.0kgf 10.0kgf 29

20

35 grade3 MMT 55 4 6.4kgf

8.4kgf 5.8kgf 11.0kgf(STEF)- 99 100

ADL

38

63

GBS

GBS

grade4

NCS 1grade3

3.55NCS

GBS IVIg

30.35 ( 20.5 )38

63

IVIg

1

― 89 ―

1

― 90 ―

35

2

― 91 ―

― 92 ―